The Nursing Contribution to Integrated Care in Canterbury, New Zealand: a qualitative study.

I would like to acknowledge both The Florence Nightingale Foundation and The Royal College of Nursing who funded this travel scholarship. I would also like to thank my employing organisation at the time of undertaking this scholarship, and The Ipswich Hospital NHS Trust for allowing me the study time to undertake this evaluative study.

I would also like to acknowledge the welcoming and openness of all staff I engaged with during this study from Canterbury. In particular Mary Gordon Chief Nurse and Becky Hickmott,  Nurse Manager – Nursing Workforce Development from the Canterbury District Health Board without whom this study would not have been achieved.

KEY FINDINGS

The aim of this study was to understand how nursing has developed and contributed to integrated care in Canterbury, New Zealand, which is an internationally recognised centre of excellence for integrated care (Timmins and Ham, 2013). Using case study methodology (interviews, focus groups and observation) this study has identified key themes through which the contribution of nursing is explored; these five themes are; An Integrated System Approach, Nursing Leadership, Integrated Care Services, Education and Information Technology as enablers, and Areas for Further Development.

Through thematic descriptions and analysis the components to effective integrated working from a nursing perspective in the Canterbury case site have been identified. A clear vision and senior leadership support for integrated working is required, and an understanding that this cultural shift takes time and stability of senior team leaders to develop. Integrated working can be seen being role modelled at all levels within the system, through the development of meetings and group decision-making and also through trusted working relationships across organisations.

Key groups, such as the Directors of Nursing meeting and the Clinical Networks act as the framework for developing services and joint working. Many of the services developed to improve integrated working were nurse led or had nursing involvement e.g. Acute Demand Service and Community Rehabilitation Enablement and Support Team (CREST).  The two key enablers to integrated working were viewed as education e.g. New Entrant into Practice Programme and information technology such as the Health1 system  increasing care record sharing between providers.  Evaluation criteria should be clear when developing new service provision and the outcomes of these visible to frontline staff.

Participants identified areas for further development, particularly in the areas of care coordination, skill mix within nursing at both advanced practitioner and support level roles, equity of services for minority groups and those socially deprived, and strengthening of the patient voice.

The findings have relevance to the development of integrated care within the U.K in terms of service, educational provision and ensuring nursing leadership is fully engaged with integrated system developments.

BACKGROUND

The Canterbury site was chosen as a previous study published by the Kings Fund (Timmins and Hams, 2013) identified this as a system which was transforming with indications of improving care. This study particularly focuses on the nursing contribution to integrated working.

Data was obtained by in depth interviewing of individuals (n= 30) and focus groups of between 2 to 7 participants (n=15). The participants were chosen to maximise what could be learnt (Stake, 1995). I have made no attempt to determine the prevalence or frequency of a phenomenon.  Sampling was, therefore, purposeful to obtain rich data in the timeframe I had available, and this was supplemented by some observational data in practice settings; observations of key meetings and retained documentary evidence supplied to the researcher whilst in the case site.

The interviewees and members of the focus groups were identified by a senior nursing link within the Canterbury District Health Board in conjunction with the researcher; with additional individuals being identified during the early data collection phase chosen for their special knowledge of the subject under study.

During the three week data collection in New Zealand the researcher undertook staged reviews of the data collected to generate the initial themes, and code the data accordingly which were then able to be presented for challenge to key stakeholder participant’s ‘in the field’ on two separate occasions to test the developing themes and underpinning categories.

APPLICATION TO WORKING IN THE UK.

Understanding how nursing practice, leadership and underpinning education impact on the functioning of an effective integrated healthcare system has started to inform the model of nursing care developed within the Suffolk Health care system. I have shared some of the content from this study at the trust leadership forum, and through email links between colleagues from Canterbury and Ipswich a visit is planned from a Nurse Educator from Canterbury to Ipswich in September 2015.

University Campus Suffolk is looking at developing their pre-registration placement support using some of the aspects the Dedicated Education Unit model.

I intend to submit a shortened version of this work to the Journal of Integrated Care and this can then disseminate the nursing services and nursing leadership findings more widely.

I will also use this information within my Regional Chief Nurse role in developing support frameworks for senior nurse leaders, and presenting the findings in nursing forums to help in the development of integrated care Vanguard sites.

The knowledge and experience acquired will be disseminated via my university linkage as Visiting Professor for Nursing at University Campus Suffolk.

I have presented some of the workforce and education innovations identified within the study to members of the Health Education East of England (HEEE). I am the regional representative on the National Workforce board chaired by Jane Cummings, Chief Nursing Officer for  England, and will make sure that the learning from this study is disseminated via this group.